Small Deviations: Vertical, Horizontal, and Combined.

INTRODUCTION AND PURPOSE: Symptomatic, small-angle strabismus is largely an acquired problem of adults that has previously been managed with prism spectacles. This paper will explore surgical options that are becoming increasingly popular.

METHODS: The special issues that confound surgical treatment of small-angle strabismus are considered. Surgical procedures described in the literature and in the author's experience that address these issues are reviewed.

RESULTS: Several recently described surgical techniques show promise for treatment of small-angle strabismus in adults. Their use is illustrated in a case report. Review of the author's practice shows a rapid increase in surgery for small-angle strabismus.

CONCLUSIONS: Surgical strategies for small deviations are increasingly important to meet the spectacle-free expectations of our adult patients.